AccountId: 011433970860
ContactId: d863f8c1-a568-4381-a7d8-acf255152ba5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344730 ms
Total Talk Time (AGENT): 178294 ms
Total Talk Time (CUSTOMER): 105534 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/d863f8c1-a568-4381-a7d8-acf255152ba5_20250415T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to see if a patient needs a prior off for a procedure.
[AGENT][NEUTRAL] OK, I can help you with authorization. Uh, can I please get your name and your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[CUSTOMER][NEUTRAL] And I guess I'm confused on his card, um, so I called the first number which was under um 90 degrees is what it said to call and then they gave me your number but I don't see that anywhere on here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK. All right. And um.
[CUSTOMER][NEUTRAL] Is the would the patient employee number be the same thing?
[AGENT][NEUTRAL] Does it start with a D?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, that's not one of our policy numbers, but I can look him up and see if there is uh a policy for it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][NEUTRAL] Uh, hang on just a second.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] Oh no, I don't have he didn't give us that.
[AGENT][NEUTRAL] OK, let me see if I can find him by his name.
[AGENT][NEUTRAL] And can you please let me know what state he lives in? I've got several.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] [PII]. OK, let me check real quick.
[AGENT][NEUTRAL] OK, thank you. And then also um what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Avera Holy Family Hospital.
[AGENT][NEUTRAL] OK, so he's gonna need benefits for his hospital indemnity plan it looks like.
[AGENT][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] And it's for an outpatient imaging.
[AGENT][NEUTRAL] Outpatient imaging, OK, he does not uh require prior authorization and this is just to verify his benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] And as far as benefit information goes, it is 90 degrees that you would need to talk to for the benefit information, which.
[AGENT][NEUTRAL] I can transfer you to them and give you the number that we use.
[CUSTOMER][NEGATIVE] So I just talked to them and they said the plan he has through them is just a preventative service only and that the CPT number I gave him wasn't covered.
[AGENT][NEUTRAL] OK. All right, so you already got the benefits from them then, but he does not.
[CUSTOMER][NEUTRAL] So then they told me to call you.
[CUSTOMER][NEUTRAL] For hospital stuff.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because they said he does have some stuff through the hospital that's covered, but it would be through you guys.
[AGENT][NEUTRAL] Right, correct. All right. So, and, and like I said, this is just to verify his benefits. It's not a guarantee of payment. He has a hospital admission benefit one day per calendar year if he's admitted for 18 hours or more. Is that going to be?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] The case, OK. He also has uh an accident and sickness surgical benefit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] He has a diagnostic testing benefit that pays $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's probably what this would be under because it's for a CAT scan.
[AGENT][NEUTRAL] OK, yes ma'am. Diagnostic testing, he gets 2 a year that pay $100.
[AGENT][NEUTRAL] If
[CUSTOMER][NEUTRAL] And then he has to pay all the rest?
[AGENT][NEUTRAL] Uh, we don't give patient responsibility, so this policy is an indemnity plan, meaning that it's a set amount for a covered procedure.
[CUSTOMER][NEUTRAL] OK, so, but I don't need to he doesn't require a prior off to have it done?
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] It's not a major medical insurance.
[CUSTOMER][NEUTRAL] OK, so if I told him to call though, um, I guess if I were the patient, I'm just thinking if this was myself, um, when you say that they pay $100 I feel like we should let him know that if he's gonna get the bill for the rest.
[AGENT][NEUTRAL] Of course, yes.
[CUSTOMER][NEUTRAL] And can he call and get that information?
[AGENT][NEUTRAL] Yes, he can call and get that information. The, the maximum amount paid for the test is $100. If he has to come in for a follow-up test after the initial test, then it pays $25.
[AGENT][NEUTRAL] And it gets one follow-up visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I don't need to prior off, but he needs, needs to know that's what he'll have to pay.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good thank you.
[AGENT][POSITIVE] You're so welcome. Is there anything else, Ms. [PII], I can, my name is [PII].
[CUSTOMER][NEUTRAL] And what was your name?
[CUSTOMER][POSITIVE] [PII], OK, thank you.
[AGENT][POSITIVE] Yes. You're welcome. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] No
[AGENT][POSITIVE] Well, you have a wonderful week and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] You too.